Uterine Fibroids

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Treatment

Treatment for uterine fibroids varies. It often depends on the patient's age, the size and location of the fibroids, and whether or not the patient may want to become pregnant. Uterine fibroids that do not cause symptoms usually do not require treatment.

Medications
Mild pain may be treated using over-the-counter or prescription pain relievers (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs; ibuprofen], acetaminophen). In some cases, hormone treatment (e.g., leutenizing hormone-releasing hormone [LHRH], gonadotropin-releasing hormone [GnRH] agonists, anti-hormone drugs [mifepristone]) can be used to reduce the size of uterine fibroids.

Hormone therapy can be used to relieve symptoms temporarily or to make it easier to remove the growths surgically. However, when treatment is discontinued, uterine fibroids often grow again.

Side effects of this treatment include the following:

• Depression
• Difficulty sleeping
• Hot flashes
• Joint and muscle pain
• Reduced sex drive (libido)

Surgery
Uterine fibroids that cause moderate or severe symptoms may require surgery. A number of surgical procedures are available to treat this condition. The method used depends on several factors, such as the patient's age and whether she may want to become pregnant, and the size and location of the fibromata.

Types of surgery include the following:

• Endometrial ablation
• Hysterectomy
• Myolysis
• Myomectomy

Endometrial ablation involves destroying the lining of the uterus (endometrium) and the surface layer of smooth muscle (myometrium) using a laser, a thermal balloon (fluid-filled balloon inserted into the uterus and heated to destroy tissue), electrical current (called electrocoagulation), or surgical instruments. Endometrial ablation can be performed vaginally (i.e., through a hysteroscope) or through an incision in the abdomen (either laparoscopic or traditional open surgery). Following this procedure, women are unable to become pregnant.

Hysterectomy is surgical removal of the uterus. This treatment may be used in women with severe uterine fibroids who do not wish to have children. Hysterectomy may also include removing other parts of the female reproductive system, such as the cervix, ovaries, and fallopian tubes. The procedure may be performed vaginally (called vaginal hysterectomy) or through an incision in the abdomen (called abdominal hysterectomy). Following hysterectomy, most patients remain hospitalized for 3 to 5 days. Recovery from the procedure usually takes about 6 weeks.

Myolysis involves using electrical current passed through a needle to destroy blood vessels that supply the uterine fibroids and allow them to grow. This procedure, which usually is performed through a small incision in the abdomen, may affect fertility.

In myomectomy, uterine fibroids are removed without damaging healthy tissue. This surgical procedure, which usually does not affect fertility, often is performed through small incisions using instruments passed through a laparoscope or hysteroscope.

Newer procedures that may be used to treat uterine fibroids include uterine fibroid embolization (UFE; also called uterine artery embolization [UFE]) and focused ultrasound (e.g., ExAblate® 2000 System). In uterine fibroid embolization, the blood supply to the fibroma is cut off, causing the growth to shrink in size. This procedure, which is performed by an interventional radiologist, generally carries less risk and requires a shorter recovery period than traditional surgical procedures, such as hysterectomy and myomectomy.

Complications from the procedure include a small risk for bleeding, infection, which can be treated with antibiotics, and early menopause. Uterine fibroid embolization may affect fertility and the procedure cannot be used in all cases.

The ExAblate® 2000 System uses magnetic resonance imaging (MRI scan) and focused ultrasound to treat uterine fibroids. In this treatment, which can last as many as 3 hours, an MRI scanner is used to locate uterine fibroids and high-frequency sound waves are used to heat and destroy abnormal tissue. This treatment cannot be used to treat fibroids that are located near certain organs, such as the bladder. Long-term effects of focused ultrasound are unknown at this time.

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